Date:___________    Payment cash_____cheque#____

Abby Roller Hockey League

 

REGISTRATION FORM

 

 NAME: (Last Name) ________________, (First Name) _____________

Birth date: _____________ Age: _____

Address: ______________________________

City: ___________________

Postal: _____________ Phone: ___________________

Emergency Contact Name: ________________ Phone: ________________

 

Email Address (mandatory):______________________________ 

 

 

PLEASE CHECK ONE OF THE FOLLOWING:

 

Preferred position: PLAYER___ GOALIE___

If goalie has been chosen, do you own equipment? YES___ NO___

Did you play in the Abby Roller hockey league before? YES___ NO___

How would you rate your level of roller hockey play?

EXCELLENT___ GOOD___ AVERAGE___ BEGINNER___

 

Friend request: (one only) __________________________

 

Have you played ice hockey?  YES___ NO___ If yes, how many years? ___

 

VOLUNTEER COACHES AND ASSISTANT COACHES NEEDED

Would a parent/guardian/friend of the above child wish to participate as a;

Coach Yes___ No___

Assistant Coach Yes___ No___

If yes thank you, Name _____________________

Email= ____________________________

 

 

I certIfy and agree to carry out fully all rules and regulations of the Abbotsford

 Rollerhockey League. WAIVER AGREEMENT:  In consideration of this application, I do herby,

for myself, parents, or guardians,  heirs, executers, administrators, and assigns, remiss,

release,  and forever discharge the Abbotsford Roller hockey league, its officers,

successors, member associations,  and anyone acting on their behalf from

 all manner of litigation, damage claims or demands in law  or in equity which I may

have acquired by reason of personal injuries to myself, loss or damage to  myself 

 of property,  which may occur during or by reason of my participation in games

 under  its jurisdiction.  This certificate has been issued at the discretion of the

Abbotsford Roller Hockey League and may be suspended by them for cause.

 

_____________________     

             
Signature of parent or Guardian

______________________

            relationship to player